Long waiting times are a common feature and a major concern in many public health care systems. They are often characterized as inefficient because they are a burden to patients without generating any gains for providers. There is an ongoing debate in Germany regarding the preferential treatment given to private health insurance (PHI) holders while statutory health insurance (SHI) holders face continuously increasing waiting times. In order to tackle this problem in the outpatient sector, Germany initiated a reform in 2015 which was aimed at providing SHI holders with appointments within an acceptable time frame. We exploit longitudinal experimental data to examine waiting times for six elective outpatient treatments in Germany for PHI and SHI holders before and after the reform. We find a considerable difference in waiting times favoring private patients. For SHI holders, waiting times remained stable over time (27.5 days in 2014, 30.7 days in 2016, Δ 3.2 days, p-value=0.889) while PHI holders experienced a significant improvement (13.5 days in 2014; 7.8 days in 2016; Δ 5.7 days, p-value=0.002). The results indicate that even after the reform there is still an unequal access to elective outpatient treatment depending on the patient’s insurance status.
What is the impact of private for-profit (PfP) hospital ownership on costs and quality of care? In light of a substantial and increasing share of PfP hospitals in many hospital markets like the USA or Germany, this is an important question. We estimate the effect of PfP ownership on hospital 30-day- and 1-year-mortality outcomes and hospital costs by focusing on heart attacks and pneumonia, two very common conditions in healthcare markets. We use rich administrative hospital data from Germany for the years 2006–2015. Applying differential distance as instrument for hospital choice, we imitate randomization of patients into PfP hospitals. Our results suggest that PfP hospitals have no higher mortality rates for heart attack treatment than public ones. For pneumonia patients, we even find lower 30-day-mortality rates of PfP hospitals compared to public hospitals. Finally, we show that PfP hospitals have higher hospital costs than public or private not-for-profit hospitals for both conditions.
Klaus Focke ist Leiter der Abteilung Versorgungsmanagement des BKK Dachverbandes e.V. in Berlin Christiane Wuckel ist Wissenschaftliche Mitarbeiterin im Kompetenzbereich Gesundheit am Rheinisch-Westfälische Institut für Wirtschaftsforschung (RWI) in Essen Prof. Dr. Ansgar Wübker ist Stellvertretender Leiter des Kompetenzbereichs Gesundheit am Rheinisch-Westfälische Institut für Wirtschaftsforschung (RWI) in Essen Politik und Experten von Krankenkassen und Krankenhäuser sowie die für die Krankenhausplanung zuständigen Länder suchen seit langem nach Qualitätskriterien für die Krankenhausplanung. Dabei geht es nicht nur um die Frage, welche Krankenhäuser aus qualitativen Gründen "vom Netz genommen" werden können. Es geht auch darum, nach welchen fachlichen Kriterien die bestehende Krankenhausstruktur selbst oder die Zuordnung von Patienten zur bestehenden Krankenhausstruktur optimiert werden können. Ein strukturqualitatives Kriterium könnte die ärztliche Qualifikation in den Krankenhäusern bzw. Fachabteilungen sein. Ein hierzu entwickelter Algorithmus könnte erste Hinweise für qualitätsorientierte Krankenhausplanungsund Konzentrationsprozesse oder auch die (um-) Steuerung von Patientenströmen liefern.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.